A dry mouth condition, known as xerostomia, is one of the more common causes of halitosis. It also is a common reason why people suffering from xerostomia experience increased tooth decay and gum disease. Saliva plays many important roles in the oral environment. When there is a deficiency in salivary production the bacterial concentrations in the mouth increase, and the saliva’s ability to wash particulate matter and plaque away are decreased due to the lack of saliva or the higher viscosity of the saliva. The saliva’s buffering capacity is also hindered. The pH levels of the saliva also change and provide a more conducive environment for certain types of anaerobic bacteria to grow. For patients in our practice who experience chronic xerostomia we recommend more frequent examinations and teeth cleanings (prophylaxis), and also regular use of prescription grade fluoride gels or solutions in order to prevent tooth decay and periodontal disease.

Xerostomia also plays a big role as one of the most common contributing factors to chronic halitosis. Because of the pH changes there is an increase in the odor producing gram (-) anaerobic bacteria in the oral cavity.  In addition when the the saliva content decreases the volatile sulfur compounds (VSC) that are produced by these bacteria tend to volatilize or evaporate more readily. The VSCs are the molecules of odors that we smell when someone is suffering from halitosis. The VSCs tends to have a rotten egg or sulfur-like odor. A sewer-like odor is another common description of the VSCs.

Common Causes of xerostomia are:

1.     Age – As one ages the saliva glands tend to produce less saliva.
2.     Medications – There is a plethora of medications that can produce xerostomia as a side effect. The most common medications that are responsible for causing xerostomia are anti-hypertensive medications, various cardiac medications, anti-depressant medications and other drugs used for treating psychiatric conditions.
3.     Diet – A high salt diet can result in a dry mouth condition.
4.     Alcohol based mouth rinses – Frequent use of these types of mouth rinses can quickly and drastically dry the mouth.
5.     Excessively frequent tooth brushing
6.     Various medical conditions such as Sjögrens disease
7.     Smoking
8.     Radiation treatment to the head and neck region

The treatment of xerostomia is difficult, and unless there is an obvious cause from an external source such as alcohol mouth rinses or excessively frequent brushing we are usually dealing with a physiological condition. Physiological conditions are very difficult to change or eliminate. Changing a patient’s medication or dosage can sometimes help with a dry mouth problem. Drinking lots of water (at least 64 oz. of water per day) is another good place to start. Avoiding smoking is also of benefit. Although there are prescription medications available for treating xerostomia, none of these work perfectly, and they all have significant side effects. On our web site we have a number of different saliva stimulating products that are helpful in stimulating more saliva. Chewing sugarless gum is also helpful. Regardless of whether you use a gum or some kind of lozenge it is important to make sure that they are sugarless so that you don’t promote tooth decay. Overall it is important not to do things to exacerbate a condition of xerostomia.

About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.